Community Intervention- Teaching Cardiopulmonary Resuscitation in Two Schools in Madrid

Keywords

Cardiopulmonary resuscitation; Teaching; Emergencies; Schools

Abstract

Background: Coronary heart disease is the most important cause of death in the world. In Europe, cardiovascular disease represent 40% of total deaths among people aged less than 75 years and sudden cardiac arrest 60% of death in adults with coronary heart disease. Immediate cardiopulmonary resuscitation can double or even triple the survival of cardiac arrest.

Objectives: The main objective of the study was to increase knowledge of first aid among school students. This study also aimed to establish how much influence has variables like sex, parents’ educational background, social and economical factors over learning.

Methods: Two schools, one public in a disadvantaged neighborhood and one private in one of the richest areas of Madrid, Spain were selected. CPR training consisted of theoretical lesson followed by practice on manikins. Multiple choice questionnaires were provided before and after the training. The results were processed using central and dispersion-tendency statistics.

Results: In total, 85 school students aged between 14 and 19 year-old completed the training. Only 10.6 % of the students received previous training. Pre-test score was higher among public school students, but post-test evaluation showed better results among private school students. The parent’s educational background didn’t influence the outcomes.

Citation

Gutu CS, Gallardo MJA and Vasquez MR. Community Intervention- Teaching Cardiopulmonary Resuscitation in Two Schools in Madrid. J Gen Med. 2018; 2(1): 1008.

Introduction

Cardiac arrest is a major public health issue. Sudden out-of-hospital cardiac arrest is the third leading cause of death in industrialised nations. Alone in Europe, more than 350.000 people are affected yearly [1]. Survival rate can increase up to two-three times when cardiac arrests are witnessed and attended by persons able to provide immediate resuscitation [2-4].

Training Basic Life Support among general population provides appropriate first aid and improves outcomes. Several Scandinavian studies prove the successful resuscitation courses of adults among school students.

Therefore, the aim of this study was to describe learning outcomes among school students, trained and supervised by medical trainees.

Methods

Study design and participants

In this quasi-experimental study, convenience sampling was done by emailing different private and public schools in Madrid, Spain. One private and one public school were willing to participate. In total 85 Students aged between 14 and 19 were collected. School students were taught in groups of 20-35 participants and the directors of each of these schools approved the project.

Teaching Material

The students completed at the beginning of the teaching session the multiple-choice questionnaire. After the pre-test the students had a one-hour theoretical class about Cardiac Life Support with different slides and videos explaining individual skills (reanimation in adults, reanimation in kids and other emergencies like unconsciousness, acute hemorrhages and choking) [5-7]. During practical exercises that lasted an average of one hour, the students were divided into small training groups with manikins. They practiced the full sequence of cardiopulmonary resuscitation, including the use of Automated External Defibrillator (AED) and the techniques were corrected by the instructors. Finally they had clinical cases which were needed to be solved in teams. After the practical session the same questionnaire used as post-test was completed.

Instructors

Three medical trainees from Hospital Universitario San Carlos of Madrid, all of them Advanced Cardiovascular Life Support (ACLS) Provider, trained the students. The trainees participated in all the activities, theoretical and practical.

Instrument for analysis

A multiple choice questionnaire comprising 10 questions were provided. Each question had 5 possible answers, with only one correct answer and maximum 10 points (see Appendix).

The questionnaire was based on the theoretical class and assessed the following items: general knowledge of CPR, the sequence of procedures and other emergency situations like acute hemorrhage, epileptic seizure or chokes.

Statistical analysis

Statistical analysis was performed using the SPSS v.22.0 software for Windows. The managing of the primary data obtained through the tests consisted of the application of central and dispersion-tendency statistics. The results of qualitative analysis were descriptive. Quantitative variables have been reported as means and Confidence Intervals were set at 95%. The comparison of means and their not overlapping confidence intervals allowed establishing the statistical significance, since the sample size is small.

Results

A total of 85 students completed the CPR training. The composition was as follows: 31 male and 54 female. 90% was between 15 and 17 years-old (Table 1).

Table 1: Frequency tables.

Previous CPR training had only 10,6 % of students. 65 students had health professional parents. In the pre-test questionnaire students obtained 3.48 points 95% CI (3,47 - 4,13), while in the post-test questionnaire 7.25 points 95% CI (6.94-7.55) (Table 2).

Table 2: Pre-test and post-test scores.

In the pre-test women scored less than men (3.48 points 95% CI 3.10-3.87). This difference was lost after the training intervention (Table 3).

Table 3: Sex.

The public school scored significant better in the pre-test questionnaire [4.25 95% CI (3.84-4.65) vs. 3.06 95% CI (2.61-3.52)], but after the training a turn-over was observed [7.84 95% CI (7.31-8.38) in private school vs. 6.89 95% CI (6.54-7.24) in public] (Tables 4 & 5).

Table 4: Public school.

Table 5: Private school.

Finally no significant difference was observed among students with parents who are healthcare professionals (4.0 points vs. 3.75) (Table 6).

Table 6: No healthcare professional parents vs. healthcare professional parents.

Discussion

This study has demonstrated the effectiveness of first aid training among public and private schools. Students improved in both schools their scores in almost 3, 5 points, which is within the range if compared to similar studies [4-9]. What draws our attention is the poor level of CPR knowledge before the training (3, 8 points in the pre-test).

Regarding the social and economical factors (public vs. private) students from the public school scored better in the pre-test questionnaire. We believe such results were due to the previous knowledge of first aid training among some students. After the course the situation was reversed and the private school students showed greater retention of knowledge. We believe this could have been due to reduced number of students in every group in the private school and the higher motivation showed during the training [9,10].

Male students scored better than females at the pre-test, but after training such a significant difference was not found anymore. It was also thought that having health professional’s parents can influence the knowledge of first aid. Such significant difference was not observed in our study.

The BLS training of the general population is an important goal and this study has demonstrated the improvement of knowledge of first aid among school students. Considering that cardiac arrest occurs predominantly in the community, the effects of early community interventions are immense. School students can be educated effectively about first aid [11,12]. They are mature enough to know the importance of such trainings and have the required skills to perform effective cardiopulmonary resuscitation on adults. Additional advantages of such training in this population are the possibility of regular sessions in schools and the potential involvement and transfer knowledge to relatives.

Conclusion

The first aid training provided by medical trainees in schools was an effective learning method for students. With the obtained results in BLS education in schools more studies are needed, even among school teachers [10].

References

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2. American Heart Association. Highlights of the 2015 American Heart Association guidelines update for CPR and ECC. 2015.

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9. Ribeiro L, Germano R. Medical Students Teaching Cardiopulmonary Resuscitation to Middle School Brazilian Students. Arq Bras Cardiol. 2013; 101: 328-335.

10. Gagliardi M, Neighbors M, Spears C, Byrd S, Snarr J. Emergencies in the school setting: are public school teachers adequately trained to respond? Prehosp Disaster Med. 1994; 9: 222-225.

11. Van Raemdonck V, Monsieurs KG, Aerenhouts D. Teaching basic life support: a prospective randomized study on low-cost training strategies in secondary schools. Eur J Emerg Med. 2014; 21: 284-290.

12. Kanstad BK, Nilsen SA, Fredriksen K. CPR knowledge and attitude to performing bystander CPR among secondary school students in Norway. Resuscitation. 2011; 82: 1053-1059.